Brazilian Psychiatric Association guidelines for the management of suicidal behavior. Part 2. Screening, intervention, and prevention

This article continues our presentation of the Brazilian Psychiatric Association guidelines for the management of patients with suicidal behavior, with a focus on screening, intervention, postvention, prevention, and promotion. For the development of these guidelines, we conducted a systematic review of the MEDLINE (via PubMed), Cochrane Database of Systematic Reviews, Web of Science, and SciELO databases for research published from 1997 to 2020. Systematic reviews, clinical trials, and cohort/observational studies on screening, intervention, and prevention in suicidal behavior were included. This project involved 14 Brazilian psychiatry professionals and 1 psychologist selected by the Psychiatric Emergencies Committee of the Brazilian Psychiatric Association for their experience and knowledge in psychiatry and psychiatric emergencies. Publications were evaluated according to the 2011 Oxford Center for Evidence-Based Medicine (OCEBM) Levels of Evidence Classification. Eighty-five articles were reviewed (of 5,362 initially collected and 755 abstracts on the drug approach). Forms of screening, intervention, and prevention are presented. The intervention section presents evidence for psychotherapeutic and drug interventions. For the latter, it is important to remember that each medication is effective only for specific groups and should not replace treatment protocols. We maintain our recommendation for the use of universal screening plus intervention. Although the various studies differ in terms of the populations evaluated and several proposals are presented, there is already significant evidence for certain interventions. Suicidal behavior can be analyzed by evidence-based medicine protocols. Currently, the best strategy is to combine several techniques through the Safety Plan. Nevertheless, further research on the topic is needed to elucidate some approaches with particular potential for intervention and prevention. Systematic review registry number: CRD42020206517

Increased risk of health professionals to feel traumatized during the COVID-19 pandemic.

Health professionals may be a vulnerable group to posttraumatic stress symptoms (PTSS) during the Coronavirus disease 2019 (COVID-19) pandemic. To investigate how health professionals who experienced a traumatic event are expressing PTSS and factors related to risk for higher PTSS symptomatology can inform how health professionals are facing their role in this crisis. This was an Internet cross-sectional survey. Participants were 49,767 Brazilian health professionals who have ever faced a traumatic event, which was about 25.9% of an initial sample of health professionals. PTSS symptoms were assessed using the Impact of Event Scale-Revised (IES-R) and latent profile analysis (LPA) explored subpopulations within participants based on their scores. Distinct profiles were compared for psychological distress (e.g., depression and anxiety) and quality of life. Multinomial logistic regression analysis was conducted to investigate the relationship between IES-R profiles and COVID-19 related experiences, thoughts, and perceptions. A two-profile model was the most appropriate for the IES-R data pointing out a group with a high level of PTSS (named high-PTSS; n = 10,401, 20.9%) and another expressing a low level of symptoms (named low-PTSS; n = 39,366, 79.1%). The high-PTSS profile demonstrated worse psychological scores (global psychological distress, somatization, depression, and anxiety) and worse quality of life (physical, psychological, social, and environmental) with moderate magnitudes. Small but significant predictors of the high-PTSS profile included sociodemographic characteristics and COVID-19 related experiences, thoughts, and perceptions. Most individuals who experienced a traumatic event were not in the high-PTSS profile. For those who were, however, psychological and quality of life measures were much worse. During the initial phase of the COVID-19 pandemic, several characteristics emerged as risks to report trauma.

Brazilian Psychiatric Association guidelines for the management of suicidal behavior. Part 2. Screening, intervention, and prevention.

This article continues our presentation of the Brazilian Psychiatric Association guidelines for the management of patients with suicidal behavior, with a focus on screening, intervention, postvention, prevention, and promotion. For the development of these guidelines, we conducted a systematic review of the MEDLINE (via PubMed), Cochrane Database of Systematic Reviews, Web of Science, and SciELO databases for research published from 1997 to 2020. Systematic reviews, clinical trials, and cohort/observational studies on screening, intervention, and prevention in suicidal behavior were included. This project involved 14 Brazilian psychiatry professionals and 1 psychologist selected by the Psychiatric Emergencies Committee of the Brazilian Psychiatric Association for their experience and knowledge in psychiatry and psychiatric emergencies. Publications were evaluated according to the 2011 Oxford Center for Evidence-Based Medicine (OCEBM) Levels of Evidence Classification. Eighty-five articles were reviewed (of 5,362 initially collected and 755 abstracts on the drug approach). Forms of screening, intervention, and prevention are presented. The intervention section presents evidence for psychotherapeutic and drug interventions. For the latter, it is important to remember that each medication is effective only for specific groups and should not replace treatment protocols. We maintain our recommendation for the use of universal screening plus intervention. Although the various studies differ in terms of the populations evaluated and several proposals are presented, there is already significant evidence for certain interventions. Suicidal behavior can be analyzed by evidence-based medicine protocols. Currently, the best strategy is to combine several techniques through the Safety Plan. Nevertheless, further research on the topic is needed to elucidate some approaches with particular potential for intervention and prevention. Systematic review registry number: CRD42020206517.